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NAME OF THE CANDIDATE AGE & DOB GENDER QUALIFICATION SPECIALIZATION PERCENTAGE CLASS OBTAINED BE: YEAR/ SEM
: : : : : : :
II
III
IV
VI
VII
VIII
PERCENTAGE
NAME AND PLACE OF COLLEGE : UNIVERSITY YEAR OF PASSING EXPEREI CE: Sl. No. ORGN POST DEPT./AREA PERIOD PAY : :
CORRESPO DE CE ADDRESS:
PERMA E T ADDRESS:
I hereby declare that the above statements are true and complete to the best of my knowledge and belief. In the event, the information is found to be false or incorrect my candidature / appointment may be terminated without notice.